Examination of the Newborn: The Key Skills 3. The Hips

Abstract

Midwives are increasingly performing the newborn and infant physical examination (NIPE), particularly now the new Nursing and Midwifery Council (NMC) education proficiencies are inclusive of the systematic examination of the newborn infant.1 This article, the third in the series, considers the importance of the examination of the hips in this screening process. The significance of history taking, knowledge of risk factors and the hip examination are explored. The necessity for early detection and treatment of hip abnormalities, along with referral pathways that Public Health England requires, are highlighted. The impact of late detection of developmental dysplasia of the hip on the lives of families and children are also considered.

Nurses assessment of development hip dysplasia: A scoping review

“…Although 13 (n = 13; 86.7%) of the included sources, identified the Ortolani manoeuvre as an additional screening assessment (Carr and Foster, 2014;Causon, 2010;Committee on Quality Improvement, 2000;Government of South Australia, 2017;Government of Western Australia North Metropolitan Health Service, 2016;Gross and Hitch, 1979;Haugh et al, 1997;New South Wales Health, 2011;New South Wales Health, 2004;Queensland Government, 2014;Trainor et al, 1994;Victoria State Government, 2018;Way, 1991;Wright et al, 2018). Finally, assessment of legs was identified in 11 (n = 11; 73.3%) included sources (Carr and Foster, 2014;Causon, 2010;Committee on Quality Improvement, 2000;Cooke and Kiely, 2011;Government of South Australia, 2017;Haugh et al, 1997;New South Wales Health, 2011;New South Wales Health, 2004;Queensland Government, 2014;Victoria State Government, 2018;Wright et al, 2018), assessments of legs included asymmetric skin folds, leg length discrepancy, Galeazzi sign, range of movement, limitation of abduction, leg symmetry and short femur sign.…”

“…There were 18 physical assessments to detect DDH identified, detail of these assessments is provided in Figure 2. All ( N = 15; 100%) included sources identified assessments in three key areas; Barlow manoeuvre, Ortolani manoeuvre and assessment of legs (Bloomfield et al, 2003; Carr and Foster, 2014; Causon, 2010; Committee on Quality Improvement, 2000; Cooke and Kiely, 2011; Government of South Australia, 2017; Government of Western Australia, 2016; Haugh et al, 1997; New South Wales Health, 2004; New South Wales Health, 2011; Trainor et al, 1994; Queensland Government, 2014; Victoria State Government, 2018; Way 1991; Wright et al, 2018). A majority ( n = 14; 93.3%) of the sources, identified the Barlow manoeuvre as a key assessment (Bloomfield et al, 2003; Carr and Foster, 2014; Causon, 2010; Committee on Quality Improvement, 2000; Government of South Australia, 2017; Government of Western Australia, 2016; Haugh et al, 1997; New South Wales Health, 2011, 2004; Trainor et al, 1994; Queensland Government, 2014; Victoria State Government, 2018; Way, 1991; Wright et al, 2018).…”

“…All ( N = 15; 100%) included sources identified assessments in three key areas; Barlow manoeuvre, Ortolani manoeuvre and assessment of legs (Bloomfield et al, 2003; Carr and Foster, 2014; Causon, 2010; Committee on Quality Improvement, 2000; Cooke and Kiely, 2011; Government of South Australia, 2017; Government of Western Australia, 2016; Haugh et al, 1997; New South Wales Health, 2004; New South Wales Health, 2011; Trainor et al, 1994; Queensland Government, 2014; Victoria State Government, 2018; Way 1991; Wright et al, 2018). A majority ( n = 14; 93.3%) of the sources, identified the Barlow manoeuvre as a key assessment (Bloomfield et al, 2003; Carr and Foster, 2014; Causon, 2010; Committee on Quality Improvement, 2000; Government of South Australia, 2017; Government of Western Australia, 2016; Haugh et al, 1997; New South Wales Health, 2011, 2004; Trainor et al, 1994; Queensland Government, 2014; Victoria State Government, 2018; Way, 1991; Wright et al, 2018). Although 13 ( n = 13; 86.7%) of the included sources, identified the Ortolani manoeuvre as an additional screening assessment (Carr and Foster, 2014; Causon, 2010; Committee on Quality Improvement, 2000; Government of South Australia, 2017; Government of Western Australia North Metropolitan Health Service, 2016; Gross and Hitch, 1979; Haugh et al, 1997; New South Wales Health, 2011; New South Wales Health, 2004; Queensland Government, 2014; Trainor et al, 1994; Victoria State Government, 2018; Way, 1991; Wright et al, 2018).…”

“…A majority ( n = 14; 93.3%) of the sources, identified the Barlow manoeuvre as a key assessment (Bloomfield et al, 2003; Carr and Foster, 2014; Causon, 2010; Committee on Quality Improvement, 2000; Government of South Australia, 2017; Government of Western Australia, 2016; Haugh et al, 1997; New South Wales Health, 2011, 2004; Trainor et al, 1994; Queensland Government, 2014; Victoria State Government, 2018; Way, 1991; Wright et al, 2018). Although 13 ( n = 13; 86.7%) of the included sources, identified the Ortolani manoeuvre as an additional screening assessment (Carr and Foster, 2014; Causon, 2010; Committee on Quality Improvement, 2000; Government of South Australia, 2017; Government of Western Australia North Metropolitan Health Service, 2016; Gross and Hitch, 1979; Haugh et al, 1997; New South Wales Health, 2011; New South Wales Health, 2004; Queensland Government, 2014; Trainor et al, 1994; Victoria State Government, 2018; Way, 1991; Wright et al, 2018). Finally, assessment of legs was identified in 11 ( n = 11; 73.3%) included sources (Carr and Foster, 2014; Causon, 2010; Committee on Quality Improvement, 2000; Cooke and Kiely, 2011; Government of South Australia, 2017; Haugh et al, 1997; New South Wales Health, 2011; New South Wales Health, 2004; Queensland Government, 2014; Victoria State Government, 2018; Wright et al, 2018), assessments of legs included asymmetric skin folds, leg length discrepancy, Galeazzi sign, range of movement, limitation of abduction, leg symmetry and short femur sign.

Figure 2.Summary of assessments identified through scoping review.

…”

“…The Barlow test is considered positive if the infant’s hip can be manually dislocated as described (Barlow, 1962; Williams, 2018). Due to the complexity of this assessment nearly all the included sources discussed the need for extensive experience and additional training to adequately complete the manoeuvre (Bloomfield et al, 2003; Carr and Foster, 2014; Causon, 2010; Committee on Quality Improvement, 2000; Government of South Australia, 2017; Trainor et al, 1994; Wright et al, 2018). Bloomfield et al (2003) found both nurses and doctors inadequately performed the Barlow manoeuvre when rated by a specialist observer.…”